This story was produced in collaboration with

Juanita Wood checks her blood pressure while her husband Art looks on. (Susan Biddle/Washington Post)

Every morning at 10 a.m. sharp, Juanita Wood, 87, taps “okay” on a screen to start up a device that takes her blood pressure and transmits the information to her medical clinic. At 10:30 a.m., her husband, Arthur, 91, touch-starts his own device, neatly lined up next to hers. The machine calculates his blood pressure and weight and sends them off, along with a blood sugar count that he enters by hand.

The Woods, of Catonsville, Md., are participants in one of several pilot projects that home health-care providers, retirement communities and others are conducting to see if high-tech but simple devices can help doctors closely monitor aging patients at home. The goal is to help control problems before they escalate and cut back on the need for costly long-term care and hospital admissions – especially repeat hospital visits for chronic conditions.

Although proponents of health-care reform tout its potential for improving efficiency, often missing from the national debate are specific examples of how changes in the system might improve patient outcomes and reduce costs. These pilot projects are exploring some easy-to-use technology that might make a difference to patients and doctors.

“This helps us detect harbingers of a bad event for patients,” said William Russell, vice president and regional medical director for Baltimore County-based Erickson Retirement Communities, which is running the pilot program in which the Woods are participating. “Early detection systems are important because more often than not, elderly patients do not come out of hospital stays with a better outcome.”

Preventing Problems

Seniors and others with chronic health problems such as diabetes, congestive heart failure and high blood pressure often wind up in hospital emergency rooms after forgetting to take their medication or when their condition deteriorates at home without anyone noticing. When that deterioration is severe enough, patients can be forced to move out of their homes into assisted living or nursing facilities, a costly and emotionally wrenching transition. The hope is that by closely monitoring patients at home, some of these events can be avoided or managed better.

Medicare spends more than $12 billion a year on “potentially preventable” repeat hospital admissions, according to the Medicare Payment Advisory Commission, an independent agency that advises Congress. And that number, according to the commission, is likely to grow, given that the Census Bureau projects that by 2025 there will be nearly 64 million Americans older than age 65, an increase of more than a third over today’s total.

The pilot projects are not designed to have doctors diagnose illnesses remotely or to substitute for hands-on care. Instead, they are intended to allow elderly or infirm patients to get ahead of changes in their chronic conditions that could tip them into a medical emergency.

Juanita Wood, a retired secretary, had some fainting incidents possibly related to blood pressure problems. She hopes that keeping track of her blood pressure and transmitting the readings to her clinic in real time will help her avoid future episodes.

So every morning she straps on a blood pressure cuff attached to her monitoring machine, presses a button to start it up and waits for the cuff to inflate. Her pressure is recorded and then transmitted to the clinic at Erickson’s Charlestown community, where the Woods live.

Arthur Wood, a retired architect, takes his blood pressure and weighs himself. Because he is a diabetic, he also is learning how to register his blood sugar levels, using a separate finger-prick device and then manually entering those numbers into his touch-screen unit. The Woods send in their information every morning, and employees at their clinic monitor the readings and alert them if something seems amiss, hopefully before anything major goes wrong.

Nurse Robin Varacalle with Arthur Wood, 91, goes over some of his numbers on a machine that monitors blood pressure, weight and blood sugar count. (Susan Biddle/Washington Post)

The monitors that the Woods use are among a variety of devices being tested in the pilot programs. Others are simple scales, to monitor sudden weight gain, which is a warning sign for those with congestive heart failure. There are also motion sensors placed under a bed, to make sure a person has gotten up in the morning, and wall sensors that can tell whether a person is moving around the house normally.

The Woods’ devices feature a smallish computer screen that comes awake when a patient taps it, displaying his or her personal information. The device is set to blink with a blue light at the same time every morning to prompt patients to do their monitoring. There’s no log-in or complex system for the device, and each machine is programmed individually to deal with one patient’s specific medical issues.

The devices are built by Intel, which has been working to develop technology to bolster home health-care services. Last spring Intel and General Electric Healthcare announced they would jointly commit $250 million to develop wireless products to connect the patient to the physician. The companies are focusing on such products because of research showing that “more than 80 percent of health-care spending focuses on patients with one or more chronic diseases,” according to Louis Burns, vice president and general manager of the Intel Digital Health Group.

A Matter Of Money

Right now, the biggest impediment to high-tech monitoring is that Medicare and private insurers generally do not reimburse for it. And the devices can be expensive. As part of a pilot project, Juanita and Arthur Wood get their devices for free; normally patients would have to pay about $100 a month to rent them.

Also, insurance plans typically do not reimburse doctors for treating patients based on data sent remotely, only for face-to-face care. Some patient advocates also worry that electronically conveyed data might be substituted for direct medical care, which the organizers of the pilot projects say is not the goal.
Instead, they say, the devices will allow doctors to accumulate data on a patient over time; this information can then be used in a face-to-face visit with the patient.

This approach allows the doctor to “spend more time with patients so they are able to plumb the depth of the patient’s problem,” Russell said.

And if the digitally sent data show that something may be going wrong, medical professionals can step in immediately rather than wait for the patient’s next routine appointment. “We set up thresholds, and anything above or below that, then the doctors get notified,” explained Kelley Gurley, project manager for the Erickson study. “If the blood sugar is low, the patient would receive a call [from the clinic] that says, ‘Please call your doctor,’ ” she said.

The device itself also is programmed to remind patients, in a friendly computer voice, about their medications and food consumption if a reading falls outside the parameters set by their doctors. In addition, a “Learn More” prompt on the touch-screen is linked to informational videos related to the data he or she has transmitted. If, for example, a blood pressure reading is high, the machine offers the patient the option of watching a short video in which a doctor explains how to bring the pressure down, such as by sitting down and relaxing for 30 minutes.

The device that the Woods use is known as the Intel Health Guide. Other companies, including General Electric, have their own home health monitoring systems. GE QuietCare is a sensor system most often used in assisted living and similar facilities to track patient activity.

Eric Dishman, general manager of Intel’s Research and Innovation Group, said these devices perform an increasingly important function: “You just can’t crank out enough medical students to solve our personnel shortage in this country. You need to rely on other means, especially technology, to bridge that gap.”

At their home one recent morning, Arthur and Juanita Wood were reminded by the flashing lights on their machines to start their monitoring process. The prompts were delivered by a female voice, which Arthur Wood noted was “sweet,” adding, jokingly, “But I love it when she says goodbye.” Because then it means he’s done for the day.

This <a target="_blank" href="/health-industry/new-technology/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is a collaboration between Kaiser Health News and

When 81-year-old Sally Darr needed nursing home care after injuring herself in a fall, her family turned to a new federal rating system for help.

The online tool uses movie-review-style ratings – one to five stars – to compare homes based on such measures as number of employees, state health inspection results and how many hours of licensed nursing care are provided each day.

“We had looked at nursing home Web sites, but they don’t give you the whole picture,” said Nancy Donaldson, one of Darr’s daughters. Their choice, Inova Cameron Glen Care Center in Reston, Va. “rated four stars pretty much across the board, and it is clean and the staff is very good.”

Donaldson is one of millions of people who have visited the site since it was overhauled and the nation’s 15,600 homes were rated in December. But there’s debate among industry and consumer groups about how well it’s meeting the public’s needs. The federal agency that runs the site plans to survey users later this year on exactly that question.

The industry, which had sought to delay the system’s rollout, complained that the grading system was started much too quickly. Nursing homes say the information, gleaned from homes as well as from state inspection reports, misleads families and patients because it doesn’t give an accurate picture of the amount and kind of care in each facility.

A leading consumer group wants the site to provide more details about inspection results and quality-of-care measures. Consumer advocates and industry representatives are calling for changes in the way the ratings assess staffing, which all sides agree is the best indicator of quality of care. Nursing homes say simple counting of workers does not reflect the care patients actually receive, while consumer advocates complain that employee information that comes from homes is unchecked and may contain errors.

‘Out of Whack’

The Centers for Medicare and Medicaid Services (CMS) developed the rating system after criticism from Sen. Ron Wyden, D-Ore., who said “something is out of whack in this country when it’s easier to find out information about a washing machine than a nursing home.” The repackaged site is more visually appealing and “takes a large amount of data and improves access to it substantially,” said Thomas Hamilton, director of the agency’s survey and certification group.

Although CMS emphasizes that no one should choose a home without visiting it, he says the data can help narrow choices. But Hamilton conceded “there has been a fair amount of misunderstandings” with nursing home operators “about areas like quality measures and staffing.”

CMS is talking to the industry, patient advocates and states about changes, including the way the system measures quality of care. For example, homes that specialize in managing pressure sores and pain have more patients with those problems, and that can skew the homes’ ratings, the industry maintains.

In addition to an overall rating, the site provides star ratings for each nursing home in three categories: performance on health inspections in the past three years, ratios of staff to patients, and 10 quality-of-care measures. Consumers can also use the site to call up specific findings from inspections, other details on each home and consumer tips.

Ratings are updated as states complete inspections. Maryland’s ratings mirror the overall national picture: About 20 percent of its nursing homes are listed as five-star and another 20 percent as one-star. Of the 33 facilities in Montgomery County, for example, six received the highest rating and five earned the lowest.

Wendy Kronmiller, who oversees inspections of 235 homes as director of Maryland’s Office of Health Care Quality, praised the system as “a great summary.” Ratings generally are accurate, she says, particularly in the upper and lower ends of the range.

As CMS weighs changes to the system, the first priority will probably be staffing information. Consumer advocates and industry representatives agree that the staffing numbers reflected in ratings don’t capture the fluctuating employment picture at many nursing homes.

Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, a trade group for nonprofit nursing homes, also contends that the current system does not count all categories of caregivers within a facility. As a result, homes may not get credit for the care they actually provide to residents.

Staffing is an important issue for consumers. Janet Chap of Chevy Chase, Md., who consulted the site when her family needed to move her father from Florida to a nursing facility in Cincinnati, said she “gave a lot of weight to the ratio of staff to patients.” Congress is considering one change: requiring homes to report their payroll data electronically every two weeks. CMS would use the data to help verify the accuracy of staff reporting.

Grading on a Curve

Other issues may not be so easily resolved. Some in the industry complain that the ratings operate like a grading curve, ensuring that similar percentages of homes will receive the highest and lowest designations. They say that makes it harder for an improving home to rise in the star system.

“Twenty percent of homes have to be one-star no matter what they are doing,” said Steve Morrisette, president of the Virginia Health Care Association, which represents many of the state’s 276 nursing homes. CMS maintains there’s adequate opportunity for nursing homes to improve their ratings.
Inspections are another major point of contention among states, patient advocates and the industry. States have varying standards, Hamilton noted, citing as an example different practices concerning use of physical restraints, which are generally discouraged. (The CMS site cautions against comparing homes in one state with those of another.)

Minnix complains that inspection data generally are inconsistent, outdated and misleading. He urges that the process be revamped with better-trained inspectors and more funding. Colleen Ryan Mallon, marketing director for Northern Virginia’s Goodwin nursing homes, says inspectors should be more objective and talk to residents more about the quality of care.

On the consumer side, the NCCNHR, formerly the National Citizens’ Coalition for Nursing Home Reform, wants more state inspection information posted online. That includes specifics on deficiencies – especially those that result in death – and the penalties levied for infractions, said Janet Wells, a spokeswoman for the advocacy group. The coalition also wants verification of self-reported, unaudited information from the homes.

Six months after it launched, the rating system’s impact is unclear. Even though CMS says the site attracts 50,000 daily visitors, both nursing homes and patient advocates suspect many families don’t know about it. Gerald Kasunic, the long-term-care ombudsman for the District of Columbia, who said he hears little mention of the five-star system, believes it “is a great tool for the next generation” – people accustomed to using the Web.

Right now, he said, many people making decisions about homes “are in a crisis and pressed to make an immediate decision,” and some simply “don’t know that the ratings exist online.”

This <a target="_blank" href="/aging/nursing-home-compare/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story was produced in collaboration with

Juanita Wood checks her blood pressure while her husband Art looks on. (Susan Biddle/Washington Post)

Every morning at 10 a.m. sharp, Juanita Wood, 87, taps “okay” on a screen to start up a device that takes her blood pressure and transmits the information to her medical clinic. At 10:30 a.m., her husband, Arthur, 91, touch-starts his own device, neatly lined up next to hers. The machine calculates his blood pressure and weight and sends them off, along with a blood sugar count that he enters by hand.

The Woods, of Catonsville, Md., are participants in one of several pilot projects that home health-care providers, retirement communities and others are conducting to see if high-tech but simple devices can help doctors closely monitor aging patients at home. The goal is to help control problems before they escalate and cut back on the need for costly long-term care and hospital admissions – especially repeat hospital visits for chronic conditions.

Although proponents of health-care reform tout its potential for improving efficiency, often missing from the national debate are specific examples of how changes in the system might improve patient outcomes and reduce costs. These pilot projects are exploring some easy-to-use technology that might make a difference to patients and doctors.

“This helps us detect harbingers of a bad event for patients,” said William Russell, vice president and regional medical director for Baltimore County-based Erickson Retirement Communities, which is running the pilot program in which the Woods are participating. “Early detection systems are important because more often than not, elderly patients do not come out of hospital stays with a better outcome.”

Preventing Problems

Seniors and others with chronic health problems such as diabetes, congestive heart failure and high blood pressure often wind up in hospital emergency rooms after forgetting to take their medication or when their condition deteriorates at home without anyone noticing. When that deterioration is severe enough, patients can be forced to move out of their homes into assisted living or nursing facilities, a costly and emotionally wrenching transition. The hope is that by closely monitoring patients at home, some of these events can be avoided or managed better.

Medicare spends more than $12 billion a year on “potentially preventable” repeat hospital admissions, according to the Medicare Payment Advisory Commission, an independent agency that advises Congress. And that number, according to the commission, is likely to grow, given that the Census Bureau projects that by 2025 there will be nearly 64 million Americans older than age 65, an increase of more than a third over today’s total.

The pilot projects are not designed to have doctors diagnose illnesses remotely or to substitute for hands-on care. Instead, they are intended to allow elderly or infirm patients to get ahead of changes in their chronic conditions that could tip them into a medical emergency.

Juanita Wood, a retired secretary, had some fainting incidents possibly related to blood pressure problems. She hopes that keeping track of her blood pressure and transmitting the readings to her clinic in real time will help her avoid future episodes.

So every morning she straps on a blood pressure cuff attached to her monitoring machine, presses a button to start it up and waits for the cuff to inflate. Her pressure is recorded and then transmitted to the clinic at Erickson’s Charlestown community, where the Woods live.

Arthur Wood, a retired architect, takes his blood pressure and weighs himself. Because he is a diabetic, he also is learning how to register his blood sugar levels, using a separate finger-prick device and then manually entering those numbers into his touch-screen unit. The Woods send in their information every morning, and employees at their clinic monitor the readings and alert them if something seems amiss, hopefully before anything major goes wrong.

Nurse Robin Varacalle with Arthur Wood, 91, goes over some of his numbers on a machine that monitors blood pressure, weight and blood sugar count. (Susan Biddle/Washington Post)

The monitors that the Woods use are among a variety of devices being tested in the pilot programs. Others are simple scales, to monitor sudden weight gain, which is a warning sign for those with congestive heart failure. There are also motion sensors placed under a bed, to make sure a person has gotten up in the morning, and wall sensors that can tell whether a person is moving around the house normally.

The Woods’ devices feature a smallish computer screen that comes awake when a patient taps it, displaying his or her personal information. The device is set to blink with a blue light at the same time every morning to prompt patients to do their monitoring. There’s no log-in or complex system for the device, and each machine is programmed individually to deal with one patient’s specific medical issues.

The devices are built by Intel, which has been working to develop technology to bolster home health-care services. Last spring Intel and General Electric Healthcare announced they would jointly commit $250 million to develop wireless products to connect the patient to the physician. The companies are focusing on such products because of research showing that “more than 80 percent of health-care spending focuses on patients with one or more chronic diseases,” according to Louis Burns, vice president and general manager of the Intel Digital Health Group.

A Matter Of Money

Right now, the biggest impediment to high-tech monitoring is that Medicare and private insurers generally do not reimburse for it. And the devices can be expensive. As part of a pilot project, Juanita and Arthur Wood get their devices for free; normally patients would have to pay about $100 a month to rent them.

Also, insurance plans typically do not reimburse doctors for treating patients based on data sent remotely, only for face-to-face care. Some patient advocates also worry that electronically conveyed data might be substituted for direct medical care, which the organizers of the pilot projects say is not the goal.
Instead, they say, the devices will allow doctors to accumulate data on a patient over time; this information can then be used in a face-to-face visit with the patient.

This approach allows the doctor to “spend more time with patients so they are able to plumb the depth of the patient’s problem,” Russell said.

And if the digitally sent data show that something may be going wrong, medical professionals can step in immediately rather than wait for the patient’s next routine appointment. “We set up thresholds, and anything above or below that, then the doctors get notified,” explained Kelley Gurley, project manager for the Erickson study. “If the blood sugar is low, the patient would receive a call [from the clinic] that says, ‘Please call your doctor,’ ” she said.

The device itself also is programmed to remind patients, in a friendly computer voice, about their medications and food consumption if a reading falls outside the parameters set by their doctors. In addition, a “Learn More” prompt on the touch-screen is linked to informational videos related to the data he or she has transmitted. If, for example, a blood pressure reading is high, the machine offers the patient the option of watching a short video in which a doctor explains how to bring the pressure down, such as by sitting down and relaxing for 30 minutes.

The device that the Woods use is known as the Intel Health Guide. Other companies, including General Electric, have their own home health monitoring systems. GE QuietCare is a sensor system most often used in assisted living and similar facilities to track patient activity.

Eric Dishman, general manager of Intel’s Research and Innovation Group, said these devices perform an increasingly important function: “You just can’t crank out enough medical students to solve our personnel shortage in this country. You need to rely on other means, especially technology, to bridge that gap.”

At their home one recent morning, Arthur and Juanita Wood were reminded by the flashing lights on their machines to start their monitoring process. The prompts were delivered by a female voice, which Arthur Wood noted was “sweet,” adding, jokingly, “But I love it when she says goodbye.” Because then it means he’s done for the day.

This <a target="_blank" href="/health-industry/new-technology/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is a collaboration between Kaiser Health News and

When 81-year-old Sally Darr needed nursing home care after injuring herself in a fall, her family turned to a new federal rating system for help.

The online tool uses movie-review-style ratings – one to five stars – to compare homes based on such measures as number of employees, state health inspection results and how many hours of licensed nursing care are provided each day.

“We had looked at nursing home Web sites, but they don’t give you the whole picture,” said Nancy Donaldson, one of Darr’s daughters. Their choice, Inova Cameron Glen Care Center in Reston, Va. “rated four stars pretty much across the board, and it is clean and the staff is very good.”

Donaldson is one of millions of people who have visited the site since it was overhauled and the nation’s 15,600 homes were rated in December. But there’s debate among industry and consumer groups about how well it’s meeting the public’s needs. The federal agency that runs the site plans to survey users later this year on exactly that question.

The industry, which had sought to delay the system’s rollout, complained that the grading system was started much too quickly. Nursing homes say the information, gleaned from homes as well as from state inspection reports, misleads families and patients because it doesn’t give an accurate picture of the amount and kind of care in each facility.

A leading consumer group wants the site to provide more details about inspection results and quality-of-care measures. Consumer advocates and industry representatives are calling for changes in the way the ratings assess staffing, which all sides agree is the best indicator of quality of care. Nursing homes say simple counting of workers does not reflect the care patients actually receive, while consumer advocates complain that employee information that comes from homes is unchecked and may contain errors.

‘Out of Whack’

The Centers for Medicare and Medicaid Services (CMS) developed the rating system after criticism from Sen. Ron Wyden, D-Ore., who said “something is out of whack in this country when it’s easier to find out information about a washing machine than a nursing home.” The repackaged site is more visually appealing and “takes a large amount of data and improves access to it substantially,” said Thomas Hamilton, director of the agency’s survey and certification group.

Although CMS emphasizes that no one should choose a home without visiting it, he says the data can help narrow choices. But Hamilton conceded “there has been a fair amount of misunderstandings” with nursing home operators “about areas like quality measures and staffing.”

CMS is talking to the industry, patient advocates and states about changes, including the way the system measures quality of care. For example, homes that specialize in managing pressure sores and pain have more patients with those problems, and that can skew the homes’ ratings, the industry maintains.

In addition to an overall rating, the site provides star ratings for each nursing home in three categories: performance on health inspections in the past three years, ratios of staff to patients, and 10 quality-of-care measures. Consumers can also use the site to call up specific findings from inspections, other details on each home and consumer tips.

Ratings are updated as states complete inspections. Maryland’s ratings mirror the overall national picture: About 20 percent of its nursing homes are listed as five-star and another 20 percent as one-star. Of the 33 facilities in Montgomery County, for example, six received the highest rating and five earned the lowest.

Wendy Kronmiller, who oversees inspections of 235 homes as director of Maryland’s Office of Health Care Quality, praised the system as “a great summary.” Ratings generally are accurate, she says, particularly in the upper and lower ends of the range.

As CMS weighs changes to the system, the first priority will probably be staffing information. Consumer advocates and industry representatives agree that the staffing numbers reflected in ratings don’t capture the fluctuating employment picture at many nursing homes.

Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, a trade group for nonprofit nursing homes, also contends that the current system does not count all categories of caregivers within a facility. As a result, homes may not get credit for the care they actually provide to residents.

Staffing is an important issue for consumers. Janet Chap of Chevy Chase, Md., who consulted the site when her family needed to move her father from Florida to a nursing facility in Cincinnati, said she “gave a lot of weight to the ratio of staff to patients.” Congress is considering one change: requiring homes to report their payroll data electronically every two weeks. CMS would use the data to help verify the accuracy of staff reporting.

Grading on a Curve

Other issues may not be so easily resolved. Some in the industry complain that the ratings operate like a grading curve, ensuring that similar percentages of homes will receive the highest and lowest designations. They say that makes it harder for an improving home to rise in the star system.

“Twenty percent of homes have to be one-star no matter what they are doing,” said Steve Morrisette, president of the Virginia Health Care Association, which represents many of the state’s 276 nursing homes. CMS maintains there’s adequate opportunity for nursing homes to improve their ratings.
Inspections are another major point of contention among states, patient advocates and the industry. States have varying standards, Hamilton noted, citing as an example different practices concerning use of physical restraints, which are generally discouraged. (The CMS site cautions against comparing homes in one state with those of another.)

Minnix complains that inspection data generally are inconsistent, outdated and misleading. He urges that the process be revamped with better-trained inspectors and more funding. Colleen Ryan Mallon, marketing director for Northern Virginia’s Goodwin nursing homes, says inspectors should be more objective and talk to residents more about the quality of care.

On the consumer side, the NCCNHR, formerly the National Citizens’ Coalition for Nursing Home Reform, wants more state inspection information posted online. That includes specifics on deficiencies – especially those that result in death – and the penalties levied for infractions, said Janet Wells, a spokeswoman for the advocacy group. The coalition also wants verification of self-reported, unaudited information from the homes.

Six months after it launched, the rating system’s impact is unclear. Even though CMS says the site attracts 50,000 daily visitors, both nursing homes and patient advocates suspect many families don’t know about it. Gerald Kasunic, the long-term-care ombudsman for the District of Columbia, who said he hears little mention of the five-star system, believes it “is a great tool for the next generation” – people accustomed to using the Web.

Right now, he said, many people making decisions about homes “are in a crisis and pressed to make an immediate decision,” and some simply “don’t know that the ratings exist online.”

This <a target="_blank" href="/aging/nursing-home-compare/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">